European Journal of Cardiovascular Medicine

Chronic dacryocystitis is the inflammation of Lacrimal drainage system or Lacrimal sac, usually occurs after obstruction of the Lacrimal outflow system, converts the Lacrimal sac a reservoir of infection and frequently caused by bacteria. This can produce chronic watering (tearing) from eye i.e. epiphora and ocular injection. Gentle pressure over the Lacrimal sac evokes pain and reflex of pus or mucus from tear puncta. It is more common in female and individuals with lower socio-economic status with habit of pond bathing.^4,5

The common clinical presentation is epiphora followed by chronic conjunctivitis, epiphora with mass (mucocele). Nasal pathology like hypertrophied inferior turbinate, Deviated Nasal Septum, Nasal polyp, Allergic Rhinitis is common predisposing factor. Complication like corneal ulcer Lacrimal abscess and fistula may occur. Immunocompromised individuals may have fungal infection.

Material and method

The present study was conducted in the Department of Ophthalmology, Nalanda Medical College and Hospital, Patna with the help of Department of Microbiology, during the period of December 2021 to December 2022. A total of 86 patients attending in EYE OPD were clinically diagnosed to have dacryocystitis who underwent clinical examination of the eyes and Lacrimal System with particular attention to drainage system were included in the study. From all the patients, a total of 86 swab samples were taken from the material which was regurgitated through the punctum following pressure on the sac by aseptic precautions and send to microbiology department for culture and antimicrobial sensitivity test.

Out of 86 patients, 81 patients were female and rest 5 patients are male. Male to female ratio was16.2:1. Out of 86 patients of chronic dacryocystitis the minimum number of 3 patients (3.4%) was in the age group of 11-20 years, and the maximum of 42 patients (48.83%) belongs to the of 41-50 years of age. 86 swab samples were inoculated in culture media, after overnight incubation at 37 degrees centigrade, growth revealed pure culture in 74 cases (86.04%), mixed culture in 7 cases (8.13%) and No growth of organism was seen in 5 cases (5.81%).

The most common organism isolated were Staphylococcus aureus in 33 cases (44.59%), Coagulase Negative Staphylococcus i.e. CONS in 14 cases (18.91%) and Candida in 3 cases (4.05%). In Gram negative bacteria 17 isolates were isolated, out of which 2 isolates (2.70%) was E. coli, 4 isolates (5.40%) were Klebsiella spp. and 11 isolates (14.86%) were Pseudomonas spp.^8,9

Table – 1 shows age and sex pattern of patients with chronic dacryocystitis

Table-2 shows organism Isolated in pure culture

Table-3 Shows antimicrobial sensitivity Pattern of conjunctival Isolates n=74)

Antibiotic susceptibility pattern Amongst S. aureus isolates, aminoglycoside group of antibiotics i.e. Amikacin and Tobramycin showed a good sensitivity of 66.66%, and 81.81%. Against beta lactam group of antibiotics like cefazolin (63.63%) and cefotaxime (66.66%) were sensitive. Moxifloxacin showed 100% sensitivity when compared to ciprofloxacin (87.8%). Chloramphenicol was found to be least effective drug with only 51.51% sensitivity.

For S. pneumoniae moxifloxacin, cefotaxime and cefazolin gave a high sensitivity of 100% followed by Ciprofloxacin 87.8% and Chloramphenicol showed a sensitivity of 51.51%.

Amongst Gram negative Bacilli (GNB) maximum isolates (100%) were sensitive to Ceftazidime which is a third generation Cephalosporin with a good antipseudomonal activity followed by Cefotaxime (82.35%). Sensitivity to Moxifloxacin was observed in 82.35% isolates as compared to 47.05% sensitivity against Ciprofloxacin. Amikacin and Tobramycin was equal effective in 64.70% of isolates.⁷

In our study organism responsible for Chronic dacryocystitis are staphylococcus aureus, Hemophilus influenza, Pseudomonas aeruginosa, E. Coli, Klebsiella species, CONS, Streptococcus Pneumoniae and Candida albicans. Our observations were in accordance with Chayakul V.¹

In this study candida albicans was also isolated. Chronic dacryocystitis caused by fungi was in accordance with a Ghose and Mahajan.²

This study concludes that Staphylococcus was the commonest offender in Pathogenesis of chronic dacryocystitis and some cases candida albicans found, which might be due to reduced immunity. In Antimicrobial sensitivity testing Moxifloxacin, Cefotaxime, Cefazolin and Tobramycin was effective in most of the Gram-positive organism whereas Ceftazidime, Moxifloxacin for Pseudomonas and Klebsiella species.

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